Cited by 111Hormonal and reproductive studiesAdrenal Hormones and DisordersMenopause: Health Impacts and Treatments

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Why Is Androgen Replacement in Males Controversial?

Cunningham, Glenn R., Toma, Shivani M.·2011·The Journal of Clinical Endocrinology & Metabolism

DOI 10.1210/jc.2010-0266

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Abstract

Context: Symptoms and signs consistent with androgen deficiency and low testosterone levels are recognized frequently in clinical practice. Recent population-based epidemiological studies indicate that low testosterone levels in men are associated with increased morbidity and mortality. The clinician must be able to counsel patients to help them determine whether testosterone replacement therapy is appropriate for them. Evidence Acquisition: The authors have conducted a literature search in PubMed, and we have reviewed references in the multiple systematic reviews and meta-analyses that have been published on this topic. Evidence Synthesis: We have attempted to provide the reader with an appreciation of the evidence that can be used to support the diagnosis of androgen deficiency, the efficacy of treatment, the potential risks of treatment, the therapeutic options, and the recommendations for monitoring treatment. Conclusions: We think that published clinical experience justifies testosterone replacement therapy in males who have not initiated puberty by age 14 and in males with low testosterone levels due to classical diseases of the hypothalamic-pituitary-gonadal axis. The benefit:risk ratio is less certain in older men and in those with chronic diseases associated with low testosterone levels. The decision to treat in this setting is much more controversial because there are few large clinical trials that have demonstrated efficacy and no large clinical trials that have determined potential risks of increasing the incidence of clinical prostate cancers or cardiovascular events. We provide a critical review of the evidence that supports treatment and potential risks and ways to reduce the risks if the physician and patient elect testosterone replacement.

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Authors: Cunningham, G. R., & Toma, S. M.
Affiliations: Baylor St. Luke's Medical Center (US)
Corresponding author: Cunningham, Glenn R.
ORCID: Cunningham, Glenn R.
Venue: The Journal of Clinical Endocrinology & Metabolism
Publisher: The Endocrine Society
Published: 2011-01-01
Volume: 96
Issue: 1
Pages: 38-52
ISSN: 0021-972X (ISSN-L)
1945-7197
DOI: 10.1210/jc.2010-0266
OpenAlex: W2129345748
Cited by: 111
References: 146
Citations by year: 2026: 2 · 2025: 1 · 2024: 3 · 2023: 3 · 2022: 1 · 2021: 2 · 2020: 2 · 2019: 1 · 2018: 2 · 2017: 4 · 2016: 10 · 2015: 11 · 2014: 17 · 2013: 23 · 2012: 17
FWCI: 2.37
Type: journal article
Language: en
Open access: closed
Locations: The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
Keywords: testosterone replacement therapy, male hypogonadism, androgen deficiency, risk-benefit assessment, prostate cancer risk, cardiovascular risk, hypothalamic-pituitary-gonadal axis, treatment monitoring, older men, chronic disease
MeSH terms: Androgens, Humans, Hypogonadism, Male, Hormone Replacement Therapy

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